Recognition that adolescents are a reservoir for several vaccine preventable diseases has led to a number of new vaccine recommendations specifically targeted to this population. However, implementation of the "adolescent platform" of vaccines, which includes the tetanus-diphtheria-acellular pertussis (Tdap), meningococcal conjugate (MCV4), human papillomavirus (HPV4) vaccines (for females) has thus far been substantially below national vaccine coverage goals. There is a paucity of data regarding effective interventions for improving vaccination coverage within the adolescent population. Our broad, long term research objective therefore is to develop and evaluate interventions to improve uptake of vaccines by this population. Patient, parent and provider barriers to, and facilitators of, adolescent vaccination are not well understood. The objectives of this proposal are to conduct formative research so as to better understand these factors, and then use this information to develop, implement and assess a multi-component intervention to improve adolescent vaccine uptake. At a minimum, the intervention will include 1) reminder/recall systems to alert parents and providers about when vaccine doses are needed, and 2) a tailored educational web-based tool to modify negative parental attitudes about adolescent vaccines. These two issues are believed to be major barriers to improving adolescent vaccine utilization. The four Aims of this proposal are: 1) To determine the baseline utilization levels of, and the clinical and personal characteristics associated with, vaccine utilization for the adolescent platform of vaccines among a defined population in Michigan;2) To assess the patient, parent and provider barriers that currently hinder adolescent vaccine utilization in this population;3) To develop, implement, and assess a multi-component intervention to improve adolescent vaccination rates within this population;and 4) To develop an adolescent vaccination "toolkit" that is based on "lessons learned" from our intervention. Impact: The expected outcome of our proposal is the development of a multi-component intervention that is effective at increasing adolescent vaccine utilization, and a provider "toolkit" that can be used to implement these interventions elsewhere. Because we intend to develop interventions that could be feasibly implemented in a variety of settings, our intervention could have a significant impact because it would be easily scaleable to broader and larger populations to improve adolescent vaccination rates. PUBLIC HEALTH RELEVANCE: Under-utilization of adolescent vaccines is a major public health concern because it leads to an increased risk of acquiring and transmitting vaccine preventable diseases. The innovative intervention approaches we propose will be able to improve upon proven strategies for increasing immunization (i.e. reminder/recall systems) and also explore novel methods for improving adolescent vaccine delivery (e.g. tailored messaging) that have been successfully applied to other preventive health care behaviors, but have not been evaluated in the realm of adolescent vaccination. Our efforts will be translated into an immunization provider toolkit which would enable our methods to be implemented in a much broader population, potentially having a substantial impact adolescent vaccination rates.